Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Hôtel Dieu, Clinical Research Unit Eco Ile de France, 75004, Paris, France.
Assistance Publique-Hôpitaux de Paris (AP-HP), Henri Mondor University Hospital, Radiation Oncology Department and Henri Mondor Breast Center and INSERM Unit 955, Immunoregulation and Biotherapy (I-Biot) Team, The Mondor Institute for Biomedical Research (IMRB), Creteil, France.
Radiother Oncol. 2023 Oct;187:109818. doi: 10.1016/j.radonc.2023.109818. Epub 2023 Jul 20.
This economic evaluation reports the incremental cost-utility ratio and national budget impact in France of accelerated partial breast irradiation (APBI) vs standard or hypofractionated whole breast irradiation (WBI) in breast cancer patients at low risk of local recurrence.
We compared 490 women randomized to the APBI (ten fractions delivered twice daily over one week) with 488 women in the WBI arm (one fraction per day delivered five days per week over three or six weeks). We took the perspective of the French national health insurance with a three-year time horizon. The outcome was quality-adjusted life years (QALYs). The incremental cost-effectiveness ratio was estimated and uncertainty was explored by probabilistic bootstrapping. Transportation and sick leave costs were added in a sensitivity analysis and a national budget impact analysis based on the incidence of breast cancer estimates in France performed.
At three years, the average cost per patient was €2,549 (±1,954) in the APBI arm and €4,468 (±1,586) in the WBI arm (p-value < 0.001), radiotherapy was the main driver of the difference between the two arms. No significant difference was found in QALYs. For an average of 60,000 new cases of breast cancer diagnosed annually in France, 28,000 would be eligible for treatment with APBI. A 100% uptake of APBI would result in a yearly30 million€ cost saving.
APBI for the treatment of postmenopausal women with early-stage breast cancer is cost saving, with no difference in outcome measured by QALYs.
本经济评价报告了在法国，局部复发风险较低的乳腺癌患者中，加速部分乳房照射（APBI）与标准或低分割全乳房照射（WBI）相比的增量成本-效用比和国家预算影响。
我们比较了 490 名接受 APBI（每天两次，每周 10 次，1 周内完成）治疗的女性和 488 名接受 WBI（每周 5 天，每天 1 次，3 或 6 周内完成）治疗的女性。我们从法国国家健康保险的角度考虑，时间范围为 3 年。结果是质量调整生命年（QALYs）。通过概率 bootstrap 法估计增量成本效果比，并探索不确定性。在敏感性分析中加入了交通和病假费用，并根据法国乳腺癌发病率进行了国家预算影响分析。
在 3 年时，APBI 组每位患者的平均成本为 2549 欧元（±1954 欧元），WBI 组为 4468 欧元（±1586 欧元）（p 值<0.001），放射治疗是造成两组差异的主要原因。两组在 QALYs 方面无显著差异。对于法国每年平均新诊断的 60000 例乳腺癌病例，其中 28000 例符合 APBI 治疗标准。如果 100%的患者接受 APBI 治疗，每年将节省 3000 万欧元的费用。
APBI 治疗绝经后早期乳腺癌具有成本效益，在 QALYs 衡量的结果方面无差异。
